Provider Demographics
NPI:1215109343
Name:MOBLEY, LETETIA HOWARD (NP)
Entity type:Individual
Prefix:MS
First Name:LETETIA
Middle Name:HOWARD
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:LETETIA
Other - Middle Name:PAULK
Other - Last Name:MOBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2111 CHAMPA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2529
Mailing Address - Country:US
Mailing Address - Phone:303-293-2220
Mailing Address - Fax:303-293-3977
Practice Address - Street 1:2130 STOUT STREET
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205
Practice Address - Country:US
Practice Address - Phone:303-293-2220
Practice Address - Fax:303-293-3977
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0990940-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71125205Medicaid